Provider Demographics
NPI:1033404942
Name:LIZARDO, MARIA CECILLE TADIAR (SLPA)
Entity Type:Individual
Prefix:
First Name:MARIA CECILLE
Middle Name:TADIAR
Last Name:LIZARDO
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:MARIA CECILLE
Other - Middle Name:REYES
Other - Last Name:TADIAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPA
Mailing Address - Street 1:433 N 4TH ST STE 101A
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4313
Mailing Address - Country:US
Mailing Address - Phone:909-576-1869
Mailing Address - Fax:
Practice Address - Street 1:433 N 4TH ST STE 101A
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4313
Practice Address - Country:US
Practice Address - Phone:909-576-1869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA4992355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASPA499OtherSLPAB